Effect of Family Practice Contract Services on the Perceived Quality of Primary Care among Patients with Multimorbidity: A Cross-Sectional Study in Guangdong, China

Family practice contract services, an important primary-care reform policy for improving primary healthcare quality in China, incorporate patients with multiple chronic conditions into the priority coverage groups and focus on their management. This study aims to explore the family practice contract services’ effectiveness in improving the quality of primary care experienced by this population. A cross-sectional study using a three-stage sampling was conducted from January to March 2019 in Guangdong, China. A multivariable linear regression, including interaction terms, was applied to examine the associations between the contract services and primary care quality among people with different chronic conditions. The process quality of primary care was measured in six dimensions using the validated assessment survey of primary care (ASPC) scale. People with contract services scored higher in terms of quality of primary care than those without contract services. Contract services moderated the association between chronic condition status and primary care quality. Significantly positive interactions were observed in the patient-centred care dimension and negative interactions were reflected in the accessibility dimension. Our findings suggest that family practice contract services play a crucial role in improving patient-perceived primary care quality and provide emerging evidence that patients with multimorbidity tend to benefit more from the services, especially in patient-centred care.

Association of anxiety-depressive disorders with irritable bowel syndrome among patients attending a rural family practice center: a comparative cross-sectional study

BackgroundComorbidity of irritable bowel syndrome (IBS) and psychiatric disorders is common, and the prevalence of at least one psychiatric disorder has been reported as high as 80% among patients with IBS.AimsTo explore the association of anxiety-depressive disorders with IBS and its different subtypes, and to evaluate the associations of lifestyle habits, dietary habits and sleeping quality with IBS.MethodsA comparative cross-sectional study was conducted at the AL-Mahsama Family Practice Center, Ismailia, Egypt. It was carried out between October 2019 and October 2020. Participants were categorised into 175 patients with IBS, diagnosed using the Rome IV criteria, and 175 patients without IBS. A semistructured questionnaire was used to collect data on sociodemographic characteristics, lifestyle habits, dietary habits and sleep quality from both groups. The Hamilton Anxiety Rating Scale was used to assess anxiety symptoms, whereas the Beck Depression Inventory Second Edition was used to assess depression symptoms.ResultsThere was a high statistically significant difference between both groups with regard to age, education, occupation and socioeconomic status (SES), being a smoker, being physically inactive, having sleep disturbance and having irregular meals; being either obese or overweight was more reported in the IBS group. There was a high statistically significant difference in the rate of anxiety and depression between patients with and without IBS. Mild, moderate and severe anxiety were reported in 37.1%, 42.9% and 20.0% of patients with IBS while most (80.0%) of the patients without IBS reported mild anxiety. Regarding depression, mild, moderate and severe depression were reported in 60.0%, 14.3% and 25.7% of the patients with IBS while most (82.9%) of the non-IBS participants reported mild depression.ConclusionsThe study shows a significant association between anxiety-depressive disorders and IBS, but no significant associations between anxiety-depressive disorders and IBS subtypes.

COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history

The study aimed to evaluate the diagnostic accuracy of contact history and clinical symptoms and to develop decision rules for ruling-in and ruling-out SARS-CoV-2 infection in family practice. We performed a prospective diagnostic study. Consecutive inclusion of patients coming for COVID-PCR testing to 19 general practices. Contact history and self-reported symptoms served as index test. PCR testing of nasopharyngeal swabs served as reference standard. Complete data were available from 1141 patients, 605 (53.0%) female, average age 42.2 years, 182 (16.0%) COVID-PCR positive. Multivariable logistic regression showed highest odds ratios (ORs) for “contact with infected person” (OR 9.22, 95% CI 5.61–15.41), anosmia/ageusia (8.79, 4.89–15.95), fever (4.25, 2.56–7.09), and “sudden disease onset” (2.52, 1.55–4.14). Patients with “contact with infected person” or “anosmia/ageusia” with or without self-reported “fever” had a high probability of COVID infection up to 84.8%. Negative response to the four items “contact with infected person, anosmia/ageusia, fever, sudden disease onset” showed a negative predictive value (NPV) of 0.98 (95% CI 0.96–0.99). This was present in 446 (39.1%) patients. NPV of “completely asymptomatic,” “no contact,” “no risk area” was 1.0 (0.96–1.0). This was present in 84 (7.4%) patients. To conclude, the combination of four key items allowed exclusion of SARS-CoV-2 infection with high certainty. With the goal of 100% exclusion of SARS-CoV-2 infection to prevent the spread of SARS-CoV-2 to the population level, COVID-PCR testing could be saved only for patients with negative response in all items. The decision rule might also help for ruling-in SARS-CoV-2 infection in terms of rapid assessment of infection risk.

Design considerations for overdose education and Naloxone distribution: Results of a multi-stakeholder workshop

Background Opioid overdose epidemic is a public health crisis that is impacting communities around the world. Overdose education and naloxone distribution programs equip and train lay people to respond in the event of an overdose. We aimed to design an open-access naloxone kit and ultra-brief education session for use in point-of-care settings. Methods We hosted a multi-stakeholder co-design workshop to elicit suggestions for the kit and education session. We recruited people with lived experience of opioid overdose, community representatives, and other stakeholders from family practice, emergency medicine, addictions medicine, and public health to participate in a one-day facilitated co-design discussion wherein large and small group discussions were audio-recorded, transcribed and analysed using thematic approaches. Results A total of twenty four participants participated in the multi-stakeholder workshop from five stakeholder groups including geographic and setting diversity. Collaborative dialogue and shared storytelling which revealed seven design considerations: recognizing overdose, how much naloxone, impact of stigma, legal risk of responding, position as conventional first aid, friends and family as responders, support to call 911. Conclusion To create an open access kit and ultra-brief education session for distribution in emergency departments, family practice and substance use treatment services, stigma is a central design consideration. Design choices that reference the iconography, type, and form of materials associated with first aid have the potential to satisfy the need to de-stigmatize overdose response.